Provider Network Relations Specialist

American Health Partners; Odessa (TX); Hybrid; USD 70,000 - 95,000; Full time

Benefits offered by this job

Health insurance

Paid time off

TeleDoc 24/7/365 access to doctors

Disability plans

Employee Assistance Plan

401K retirement accounts

Employee Referral Bonus Program

Job summary

American Health Plans is seeking a role focused on contracting providers and managing essential vendor relations to maintain CMS adequacy across current service areas. You will educate providers, monitor credentialing, and support network coverage while collaborating on policy updates and implementation.

The ideal candidate brings health care field experience, strong negotiation, and the ability to work independently and within a team to improve processes and outcomes.

Qualifications

• Experience in the health care field required.
• Prior experience in network development / network services is preferred.
• Prior experience with acute and post-acute facilities is beneficial.
• Prior experience with Medicare Advantage plans is helpful.

Responsibilities

• Contract providers and essential vendors in current service areas to maintain CMS adequacy and providing necessary services in the care of the Plan members.
• Insuring providers and essential vendors in current service areas meet the credentialing requirements for their appropriate service lines.
• Educating providers on the Health Plan(s) functions and roles in caring for its membership.
• Ongoing educational updates as prescribed by CMS and the Health Plan(s) policies.
• To conduct the education presentations of the Health Plan(s) providers to insure their understanding and commitment with the Health Plan(s).
• Monitor, maintain and support provider relationships to insure network coverage in all areas.
• To work with and be involved in implementation as needed.
• Establish a positive work environment that encourages participation in process improvement and commitment to department/company success.
• Complete corporate assignments as assigned.

Skills

Provider payment methods

Relationship building

Independence

Negotiation

Presentation skills

Time management

MS Office

Team player

Education

Bachelor's degree

Tools

Microsoft Office Suite

Job description

American Health Plans is seeking a role focused on contracting providers and managing essential vendor relations to maintain CMS adequacy across current service areas. You will educate providers, monitor credentialing, and support network coverage while collaborating on policy updates and implementation.

The ideal candidate brings health care field experience, strong negotiation, and the ability to work independently and within a team to improve processes and outcomes.